Health workers in Zimbabwe are warning that international alarm over the spreading cholera emergency, which has claimed nearly a thousand lives, is overshadowing the Aids crisis, which is killing as many people every three days.
The rising death toll from cholera, brought on by collapsed sewerage systems infecting drinking water, has become the most visible sign of Zimbabwe’s extraordinary implosion and the indifference of its leaders. As the disease spread across the border into South Africa, alarmed foreign governments promised to pour in aid to contain the outbreak.
But cholera and the failure of the sewerage system are symptoms of the wider collapse of the state and its devastating consequences.
Aid workers speak of a silent catastrophe in which people are dying of Aids by the hundreds every day for want of medicines and sufficient food to fight off the disease, and because a cynical government has blocked foreign aid workers from reaching many of the most vulnerable.
About one in five Zimbabweans are HIV-positive. The United Nations says Aids kills more than 400 Zimbabweans each day.
“This cholera is just one issue,” said Meine Nicolai, director of operations for Médecins Sans Frontières Belgium, which is working in Zimbabwe.
“It is a disease with a risk of high mortality, so we have to pay special attention to treat the patients with cholera because it can spread very rapidly. But it is just one of the problems and the result of a collapsing system that is claiming many more lives.
“The situation of the wider population is more worrying in terms of a collapsing healthcare system, very high HIV prevalence and the nutritional situation.”
Although Aids has been claiming increasing numbers of lives for years in Zimbabwe, health workers say people have been made more vulnerable to the disease by widespread malnutrition.
Many Zimbabweans, particularly in rural areas, eat one meal every two or three days because of the collapse of agriculture following the redistribution of white-owned farms and drought. Some are living off nothing more than berries and roots. With chronic malnutrition comes weakened immune systems and much greater vulnerability to Aids. Undernourishment also erodes the effectiveness of drugs that keep the disease at bay.
Some health workers say that the working-age population of entire villages has either left for South Africa to look for work or died of Aids.
The World Health Organisation says Aids is responsible for two-thirds of all adult deaths in Zimbabwe. More than 40% of deaths in children under five are Aids-related, six times the average in a region where it is rife. Life expectancy is among the lowest in the world. More than a million children have been made orphans as a result of Aids.
The dead are buried in overcrowded cemeteries where the graves are bunched together to make room for the next day’s dead. Costly headstones have given way to wooden markers for men and women who have barely made it to adulthood.
Government distribution programmes for drugs such as the one that prevents HIV-positive women from passing the virus to their babies at birth have largely collapsed. According to the Global Fund for Aids, only about one in five of those who need antiretroviral drugs to keep the disease at bay are receiving them. Those who do are generally reliant on foreign aid organisations.
The cholera crisis is not detached from Aids. Nicolai says those most at risk from dying from the disease are undernourished and HIV-positive.
“A weakened population that is undernourished, a population that has a high HIV prevalence, is even more at risk from cholera. So cholera is important, but it’s only one of the problems,” she said. — guardian.co.uk